[Physiopathology and new therapeutic strategies in the management of bone metastases of prostate cancer].

Prostate cancer (PCa) is one of the most common human malignancies that have a strong propensity to spread in the bones. Despite the progress in the diagnosis and the treatment of prostate cancer, bone metastases are present in nearly 95% of men with metastatic PCa at autopsy. Bone metastases are a major cause of skeletal complications which may negatively affect the quality of life and increase morbidity and mortality in men with advanced PCa. Bisphosphonates are potent inhibitors of bone resorption that have demonstrated clinical benefit for the treatment of bone metastases. They are standard of care for the prevention of skeletal complications such as pain and pathological fractures in patients with bone metastases from PCa. More recently, the discovery of the OPG/RANK/RANKL system has permitted to better understand the role of OPG and RANKL as key regulators of osteoclast-mediate bone destruction in both normal bone remodelling and pathologic conditions. RANKL has been shown to contribute to the vicious cycle of bone destruction and tumour growth in PCa. Therefore, the development of new emerging treatment that inhibits RANKL using RANKL antibodies, as denosumab, resulted in a better control and treatment of skeletal complications, with the hope in a near future to prevent bone metastases.